The Effects Of CTnI And Hemodynamics With Sevoflurane Combined Anesthesia On Patients With Off Pump Coronaryartery Bypass Grafting

Objective:To investigate the effects of cTnI with sevoflurane combined anesthesia on patients with off pump coronaryartery bypass grafting(OPCABG),observe the myocardio pretective effects with sevoflurane combined anesthesia.Methods:Thirty-six patients with off pump coronaryartery bypass grafting were randomly divided into two groups of sixteen patients:contrast group and sevoflurane group.The two groups patients both inhale pure oxygen and remove nitrogen,and inject midazolam,etomidate, vecuronium bromide to begin induction of anesthesia and endotracheal intubation.The control group are total intravenous anesthesia by fentanyl,propofol.Sevoflurane group are combined inhalation and intravenous anesthesia by sevoflurane,fentanyl,propofol.HR,SBP,DBP,MAP,CVP were recorded before anesthesia(t₁),before intubation(t₂),2 min after intubation (t₃),2 min after incision(t₄),2 min after cut the sternum(t₅),after blocking coronary artery and starting to bridge(t₆),after bridging over(t₇),after operating over(t₈),and2h(t₉),8h(t₁0),24h(t₁1) after ending coronaryartery bypass grafting..The venous blood samples were collected or the measurements of cTnI before anesthesia(T₁) and(T₂),2h(T₃),8h(T₄),24h(T₅) after ending coronaryartery bypass grafting.Results:1.HR,SBP,DBP,MAP:group comparison:There were no significant differences in HR,SBP,DBP,MAP among the two groups(P＞0.05);comparison within group:SBP,DBP,MAP decreased significantly after anesthesia induction in each group compared with the baseline values at t₁(P＜0.05),and stepped up after tracheal intubation,difference between maximum values and baseline values were not statistically significant but SBP.CVP step up gradually before vascular anastomosis and then descend and reach the minimum point,afterward ascending little by little.2.There were no significant differences in time course of coronaryartery bypass grafting and numbers of coronaryartery bypass grafting among the two groups(P＞0.05); There were no significant differences the time course of staying ICU(P＞0.05).The incidence rate of bradycardia is obviously higher in the control group than in the sevoflurane group.The sevoflurane group can retain preferably the stabilization of heart rate.3.cTnI:group comparison: There were no significant differences among the two groups at T₁-T₄(P＞0.05),but at T₅(P＜0.05);comparison within group:cTnI increased significantly after coronaryartery bypass grafting 8h in each group compared with the baseline values at T₁(P＜0.01);comparison of interaction:There were statistical significance in the contrast group and the sevoflurane group, (P＞0.05).There were significant differences in the diversity tendency of the two groups. Comparing of the sevoflurane group,there were significant upgrade in the control group. Conclusion:sevoflurane combined anesthesia is safe and efficacious and provides greater protection of the myocardium on patients with off pump coronaryartery bypass grafting.In spite of myocardial injury are in a relatively less degree,myocardial preservation measure is indispensable to patients with off pump coronaryartery bypass grafting.The sevoflurane group can retain preferably the stabilization of heart rate.